If a client has had prior prenatal care, I will discount a portion of each prenatal visit. If she comes late to care with no prenatal care, there is no discount.

It is fair. But when a women come to a MF late in her pregnancy with a file of prenatal records and all labs done, to expect her to pay the full fee?
It is what I am trying to understand. Because that "catch up" work involves working on very delicate things. It can't be accelerated, can they?
Yes, you can dig more holes in an hour if you try harder but you can't built a relationship during a week or two doesn't matter how much harder you try.

I am irritated with that "catch up" talk because it sound like an excuse for me to get more money. Nothing wrong in the last - a healthy desire. But I hate hypocrisy, I am sorry.

i haven't heard of OB's but i know in my province there are family physicians who have done so in the past, although i am pretty sure their association really frowns on it. and in Canada, the OB association fully supports midwifery care and place of birth, however i do not think the system is set up for OB's to attend homebirths. what about michel odent though? i wonder if he would be willing and i'm pretty sure there is one in the US ... michael rosenthal or something like that.

Your explanation is clear and makes sense even though I do not agree with how you pictured pregancy/ postpartum emotional state. But I take your word for that because of your experience.

One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?

i think part of it is that OB's are trained to deal with high risk situations and so it's really not out of the scope of their care. i'm sure they prefer to have seen women prior to birth, but it certainly isn't unusual for them to be called into emergency situations where they haven't dealt with a woman who has had prenatal care from a physician or midwife.

I don't really feel that it is hypocrisy. I mean, in midwifery, we don't exactly charge by-the-hour rates for the birth. So maybe some midwives would feel it would be hypocrisy to charge by-the-appointment rates?

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

I would not too. But when I found that there are other midwives who would agree to attend just the birth and charge less than half of their fee, I started questioning the reasons of the first ones.

The problem is that the first ones are NOT declining a client. They will take you if you pay the full fee. They want the same money as if they provided full care.

Some justify it by having to do "catch up" work: dig harder, dig deeper.

Others would want the full fee for the risk coming across a weirdo.
I just wonder wether they are going to reimburse a woman if she turns out to be one of the normal ones?

Just don't hire them if you have another option. It's their practice, they can set the rules whether or not you like them, agree with them, or even understand them. One of the midwives here charges $4000 for a homebirth...no one else in the area charges more than $2800. Now she's a CNM and the others aren't so I guess that's where the fee different comes in, but I certainly am I not paying an extra $1200 to hire a CNM vs. a CPM, and I can't imagine too many others around here are jumping at it either (unless they have insurance that would cover it if a CNM attended, then maybe). Not to mention she runs a birth center too and tells you that if you hire her for a homebirth and someone else goes into labor at the same time you have to go to the birth center...really I can't imagine why anyone would go for that if they want a homebirth knowing that could happen, but hey, her practice and we can (and do) choose not to hire her knowing her policies.

I can see asking a midwife to work with me because I can't afford to pay her fee, but NOT because she didn't do enough "work" for me.

I have not had any prenatal care as of yet. I'm 30 weeks on Thursday. We are moving, and I spoke with a midwife in the town where we are going when I was around 6 or 7 weeks. We have emailed a little bit, but not much.

She was okay with me not doing anything here (I offered to do prenatals with a mw here), and she said her fee would be less. I asked her if she was sure...I thought it would be HIGHER because she wouldn't have had time to get to know me as much, or to build mutual trust.

So, to think that her fee should be less is appalling to me.

The job of a midwife is SO much larger than the job of an OB. And, a mw in our country is starting at a large disadvantage because she is forced to run her practice as a business. She isn't just the lady in town who helps when a baby is due, you know? She has a very delicate and difficult job of melding the ob world with the mw model of care.

That's worth my respect, not my quibbling of fees.

Sure...ask for help because you can't afford it, but don't ask her to change her fee because of who you are or because you've already had prenatals or read a book or seven.

I have not had any prenatal care as of yet. I'm 30 weeks on Thursday. .

Obviously the above is not appalling to you.

Quote:

Sure...ask for help because you can't afford it, but don't ask her to change her fee because of who you are or because you've already had prenatals or read a book or seven.

I will expect a MW to change her fee because I have had prenatals, even if you tell me not to. No need to ask or tell her what to do. We all have right to do what is right for us: to have no prenatals at all at 30 weeks or find a MW who matches us better.
I am not telling you what to do but it seems to me that in your case it would be a good idea to pay your MW her full fee and even something on top. It looks like she WILL be doing much more work with you plus it is what you believe is right, isn't it?

Frankly, I have a set fee for the birth and the amount I charge for prenatals and postpartum is per visit. For example, (just going with easier math for the numbers) if I see you for 10 prenatals and postpartum visits at $50/per you would owe me $500 for those visits. I roll the fee for the first three postpartum visits into my fee for the birth (day 1,3,7) to make sure that moms don't skip those first few really important visits due to trying to save money (if something is going to go south, that is the general time period it's going to happen). I would feel I wasn't providing adequate care for my clients not being there those days. Yes, it's possible to "play" my system so you don't pay as much out of pocket, but seeing as how I offer the most lenient payment plans in the world it would take a particularly shameful person to do so. If a mom has prior prenatal care before transferring to me, she's not going to get charged for work I didn't do. However, if a mom comes to me well into her pregnancy without any care I'm going to want to know why and if the answer isn't one I can live with then I'm not going to accept her as a client. As for the birth, yes some moms will require less care and some will require more. I just can't charge by the hour for something like that, no midwife can, so we charge a rounded fee that will even things out as best as possible. Frankly, that's pretty much the way everyone does business. A doctor has a set fee that he charges for a birth and everyone pays at least that fee or more, depending on if they need extra services (such as a c-section). It all comes down to we do the best we can to ensure we provide safe, affordable, care to our clients while still covering our needs as well.

I will expect a MW to change her fee because I have had prenatals, even if you tell me not to. No need to ask or tell her what to do. We all have right to do what is right for us: to have no prenatals at all at 30 weeks or find a MW who matches us better.
I am not telling you what to do but it seems to me that in your case it would be a good idea to pay your MW her full fee and even something on top. It looks like she WILL be doing much more work with you plus it is what you believe is right, isn't it?

Whoa. Firstly, I discussed this with said midwife ahead of time (and offered to have prenatals here with the midwife for my last pregnancy). Secondly, I have a mw HERE and THERE to answer my questions as needed. Thirdly, this is my fourth baby, and I (like you claim to be) am highly read on the subject. Fourthly, I don't believe in routine labs and testing. Stuff that's symptomatic, sure...but most tests are unnecessary for the regular, healthy mom and pregnancy. (And don't get me started on how gestational diabetes isn't symptomatic. I don't even care...). Fifthly, it is possible, because of the unpredictability of birth, that the midwife could have a big job at the birth, BUT, I've had three very easy and uncomplicated births. My last midwife was here 2 hours.

AND, my situation IS different than showing up last minute and wanting care. I began developing a relationship with this midwife at SIX weeks pg.

However, the point of my comment wasn't to be bashed for my lack of BP readings over the course of this pregnancy, or my undocumented fundal height. The point was a midwife is due the respect of the fee she charges, and should not be made to feel guilty because someone has already had a few things checked out. Prenatals aren't the be all end all of a midwife's relationship. It's WHOLE body, TOTAL patient care. It's a RELATIONSHIP. And it's value isn't based on hours. (Either during prenatal care OR the birth).

I am probably going to see my midwife a total of 10-15 hours...prenatal, birth, and postnatal. And, yes, I still believe she deserves her full fee.

But this whole thread makes me want to stick out my tongue and holler "nananabooboo".

We are talking about grown-up women not babies who have no language skills and can't speak their needs, aren't we? Would you say it your client's expectations were not clear for you after the interview?

I do not understand why you need to give up on your personal life, family events, etc for 6 weeks to provide your service on the one only day when actual birth will happen.
I am not a MW and I do not know this job.

If we believe that prenatal appointments are so important and most work is done before the birth, than what should be the fee for the birth itself?

It is not the fee I am questioning. But hypocrisy: they push the service I am not asking for, claim that I need it while it is them who need/ want it and ask me to pay for it.
When it comes to money they are business women, when it comes to the service they are paid for, they feel offended with the fact that they are hired. They are free spirited artists who provide holistic care.

Why not be honest? If you can't or are not willing to provide the service I am looking for, just put it straight. Why to act like a sale person and impose the whole package which you are interested in (due to the lack of practical experience or a financial reason) but not me?

It is not directed to you, mbhf. I have no problem with anything you said in you post.

You're quite obviously NOT a midwife or you would probably not be this offensive. I don't know whether or not you mean to be, so I will assume the best and consider it ignorance, rather than willful argumentativeness.
What is your particular problem with midwives charging a global fee? I am still not getting that, even though I've read through the posts twice.
I am a midwife in training, although on hiatus right now. WHY am I not practicing and apprenticing now? Because I simply can't afford to work for free. Most midwives in my area charge between $900 and $1500 for their TOTAL fee. They just can't afford to also pay an apprentice... usually not even much to help cover gas costs.
They work VERY hard and they get paid VERY little for the skill, love and care they put into their work. Most midwives DO develop relationships with the mothers they serve. The relationships can be varied... from close friendship to a temporary connection that serves well during the pregnancy, labor/birth and after care, but naturally fades into the background as the mother moves on with her life and the midwife goes back to work.
I have gotten up at 3am to drive over an hour to help an amish couple birth their first baby. Upon arrival, I found I was at the wrong house. Since amish houses have no electricity, there are no lights, so I went to another mom who lived on the same road, due at the same time, but it wasn't her. Then, I got stuck in the mud of their yard. Couldn't be pulled out, so the poor dad had to hitch up the buggy so I could be taken to the right house where the mom was in labor. I ended up staying with them for over 18 hours, as my truck was stuck and the mom's labor was long and slow and she needed a lot of comfort and reassurance. When I finally got home that evening and got in bed, around 1030 or so... I woke up with a start at 3am again... the OTHER mom was now in labor. So, fresh clothes on and back to work, another hour drive, another long-ish birth and a beautiful happy baby and family. But exhausting, definitely!!!

I had been on call for these women and others for weeks. It's NORMAL for us to be on call for several weeks. On-call for me means I don't drink more than one glass of wine in a 24 hour period. I don't leave my hometown. I don't plan an overnight trip. I don't book other engagements. I let other clients know i may have to cancel and or rebook things if that mom goes into labor. As a massage therapist, this has cost me MONEY to have to cancel appointments for massage to attend a birth. This affects my family. I don't throw parties that i can't reasonably expect to have to leave in the middle of. I know that I may miss a party for one of my kids, or I may have to rely on family or friends to drive my kids somewhere, or chaperone them or just simply BE there for them if I cannot.
These are just some of the sacrifices I make to ensure I can be there when a client needs me. There are more, which I'm sure other midwives would be happy to list if you needed more examples.
Calling midwives businesswomen and free spirited artists who provide holistic care is a compliment to me. It sounded as if you wrote it as an insult. I don't get that. The more sucessful midwives I know are GOOD businesswomen. They make sure that their clients are very clear about payment expectations. They are clear and firm about their fees, upfront, so that the families can make budgetary adjustments and can decide to decline to hire them if the fee is beyond their range. They ALL work on a sliding scale. I have yet to meet a midwife who has not done a birth for "free" as the fee she eventually collected didn't even cover, or barely covered her expenses.
I'm not sure what your underlying angst is or seeming anger towards "hypocritical" midwives, but you have a lot of misconceptions, IMO.
Most midwives work for very modest salaries, spend a HUGE amount of time working with or for their clients and deserve a lot of credit and respect for the jobs they do.
Forgive me if my post seems harsh. I do not like to see my chosen profession disparaged so, especially when I know the truth.
- Jen

Mom of 5 working full-time and waiting to go to nursing school! Whew! I need a nap!

I haven't had a chance to read this entire discussion, so please forgive me if I repeat something, but I wanted to pass on my experience.

I was receiving prenatal care from a mw that I had to terminate services with around 36 weeks for a variety of reasons on both our sides. At any rate, I had to find new care or go for a UC. We decided to go for the UC, but my family freaked out on me saying things like I was going to die and the baby was going to die. I did a lot of research during this time about complications and talked to three different midwives about what they were and were not comfortable doing during a birth. Essentially, what some of the pp's have mentioned is a very real problem: a midwife cannot simply show up for just the birth, especially not to just catch the baby without risking a lot. She needs to have background knowledge and she needs to have knowledge of the birth progression to do her job to the best of her ability. This isn't to say that mw's don't sometimes do this or that sometimes the birth proceeds quite quickly and they show up just in time or even after the fact. But purposely putting the mw in that position is not a moral thing and can end up costing us another midwife and we need all the midwives we can get!

Now, with that explained, I'm not saying that you are asking for that situation. It sounds more like maybe you're wondering if you can switch to mw care so late in your pregnancy? And the answer to that is yes. I did in fact switch to a different mw at 37 weeks and she was perfectly fine with that. I also asked her to be very hands off, allowing me and my dh to do everything. I wanted her in the other room as back up just in case, but if everything was fine, I wanted to do it ourselves. And this was totally fine with her. IME, this is not the case of MOST mw's, however. This particular mw was very experienced and very well known within our birthing community and by OB's in the area. She is highly respected and can "get away" with stuff that other mw's could not. The other mw's I spoke with wanted to do much more during the birth than sit in the other room (even the other CPM's I spoke with) in order to maintain their licenses.

My second mw charged me 2 of the 3 parts of the global fee: the birth and postpartum fee, which is about 3/4 of the entire package, and a few other charges for things like rhogam. The prenatal care is hardly anything. So for me, I ended up paying about $2400 out of pocket up front, but once I filed with my insurance (as an out of network provider) I only paid $1000 or so in total. This process took about 6 months and required appeals, but it was well worth it. I have UHC POS, which I chose purposely for my homebirth.

All in all, you have to find a way to birth that is right for you. Birth doesn't happen every day. It has the ability to be utterly transformative if allowed to be. If it requires that you pay a little more out of pocket I think that is worth every penny.